Monthly Archives: October 2014

I’m going to start at home, though, because (as anybody who reads what I write knows) I am pretty concerned over the spread of Ebola in the US.

Which is not to say that I’m unconcerned about the spread of Ebola in West Africa. I am. Without the rampant, unchecked spread of Ebola in West Africa, there would be no spread of it in the US, after all. It came here from there in the form of Thomas Duncan, who traveled from Liberia to Dallas, Texas a couple of weeks ago.

By now, everybody knows what the Ebola germ (it’s a virus) looks like, but what kind of self-respecting blogger would I be if I didn’t repeat the picture everybody else is using?

Ebola is what we call it; its full name is Ebola virus disease or Ebola hemorrhagic fever. In case you don’t know, “hemorrhage” is just a fancy for “bleeding,” generally bleeding from someplace you’re not really supposed to be bleeding from, like internally or the mouth, eyes or ears.

One of the reasons Ebola spreads is because its initial symptoms mimic far more common diseases that, in general, we don’t worry too much about. Influenza (flu) is the big one – fever, headache, sore throat, body/muscle/joint aches, coughing/sneezing, and just feeling shitty. In the places where Ebola is common (like West Africa), it mimics other things like malaria and cholera, which have symptoms such as diarrhea and vomiting. Ebola presents with a steady progression of these things, and the virus eventually destroys the liver, kidneys and other internal organs, resulting in death for a solid 50% of the people who contract it – maybe more.

The problem with Ebola symptoms is that an infected person goes from 0 to 60 pretty quick. Ebola can incubate undetected in a person for up to 3 weeks (21 days) before slamming a person with symptoms that ramp up in just a few days. The fever (temperature of 101.5 deg. F or higher) is almost always first, and that’s the indicator that is being touted as the canary in the coal mine and being observed in airports. The really nasty symptoms, like bleeding from orifices one doesn’t usually bleed from, take about 5 days or so to show up. Once that happens, that’s pretty much it – the only thing doctors can really do for you at that point is try to keep you comfortable and put you in touch with your loved ones to say goodbye.

Initially identified in 1976 in Sudan, Ebola has been a pretty rare disease until recently, producing fewer than 2,000 infections before the 2014 West African outbreak. The current outbreak has produced over 8,000 (reported) cases and more than 4,000 (reported) deaths.

I say (reported) because the countries suffering the heaviest of the outbreak – Liberia, Sierra Leone, Guinea and Nigeria – don’t have the best infrastructure, the most stable governments, the highest number of health workers, or many of the other things that would lead to 100% accurate, up-to-the-minute statistics.

Right now, there’s no cure for Ebola, but I’m sure (as I’m sure you’re sure) that scientists and doctors are working feverishly (no pun intended) on a preventive vaccine. Treatments exist, but aren’t always successful. From what I’ve read, the best way to beat Ebola is to get a blood transfusion from somebody who has survived the infection – but that requires you have the same blood type as the survivor. It can also be treated by intensive rehydration therapy – consuming souped-up Gatorade to keep the body’s salts and electrolytes up – but again, it’s not always successful. It’s said that – so far – each infected person has the capability to infect 2 other people.

Ebola is (currently) (allegedly) only transmitted when a person comes into direct contact with the bodily fluids (blood, sweat, saliva, urine, feces (diarrhea, remember?) or semen) of an infected person. Unlike influenza, chicken pox or the common cold, this makes the virus relatively tough to pick up. (If Ebola ever goes airborne, it’ll be much easier to transmit, but that’s a different post.)

Back to my main point though – who do we blame for its spread? I said everybody, right?

Burial practices in West Africa are partly to blame. In this part of the world, we turn our dead over to a professional for processing, then embalming and burial or cremation. It’s a pretty sanitized sequence of events that doesn’t really involve us at every stage. In West Africa, though, burial practices include the family washing the body of the deceased before burial.

Washing a dead person puts you in direct contact with their infected and contagious bodily fluids, and this practice is one of the major ways scientists & contagious disease experts are blaming for the ongoing transmission of Ebola in West Africa. Changing cultural practices is incredibly difficult, though, and reports are emerging that the families of victims have been bribing officials to put anything but Ebola down as people’s cause of death so they can perform their burial rituals.

Ignorance, then, is also partly to blame. Simple ignorance of how the disease is transmitted and the fact that you can, indeed, contract the disease from a dead person. However, ignorance is pretty simple to combat and there’s a lot of effort going into informing people about how the disease passes.

There’s a lot of other minor factors in there, too, like people not respecting the 21-day quarantine period to watch for symptoms. An NBC reporter, doctor, and disease expert named Nancy Snyderman, was in Liberia for quite some time. When a member of her crew came down with Ebola, the entire unit flew back to the USA. Snyderman admitted to breaking her quarantine to venture into town for a meal. If a doctor and disease expert cannot even be counted on to respect the quarantine period, just imagine how many people who know less than she does about Ebola can’t be relied on to respect the quarantine.

“But I feel fine,” I’m sure they say. “I’m just going to the grocery store.”

The long and short of it, though, is that we can blame both the US government and the US scientific/medical community.

First and foremost, neither of these entities has taken Ebola seriously from the beginning of this outbreak, which started in March in Guinea. The UN’s medical body, the World Health Organization (WHO), declared the outbreak an “international public health emergency” in August; by that time hundreds were already dead and the spread of the disease was out of control.

The US government and its disease-oriented arm, the Center for Disease Control (CDC), has appeared to be completely inept in helping to control this outbreak. The CDC kept telling Americans not to worry, that Ebola is difficult to transmit, that we didn’t have to worry about it coming into the US. Then, they started importing it, bringing infected Americans (a doctor and a missionary, then a reporter & then the aforementioned NBC news crew) into the country on purpose, telling us all not to worry, that the infected individuals would be in isolation wards and the rest would be quarantined.

Well, we see how well that quarantine worked, now don’t we?

Then, what the CDC expressly said wouldn’t happen happened. Thomas Duncan, a Liberian, flew from Monrovia to Brussels, Belgium, then to an airport outside Washington, DC before reaching his final destination in Dallas, Texas. He told a couple of lies along the way (“Oh, no, I haven’t been in contact with any Ebola-infected people.” “Oh, no, I don’t have any symptoms, I feel fine.”) and breezed right through.

He went to the hospital after a few days in Dallas, complaining of fever and some other minor symptoms. The stories differ from that point forward, with some folks saying “We totally asked him if he’d been in Liberia” and others saying “He lied and said he was never in Liberia” and still others saying “Nobody told me nuthin’.” The point is, when he first showed up at the hospital, THEY SENT HIM BACK HOME with some antibiotics and the promise, I’m sure, that he’d be fine in a few days.

Nope.

A couple days later, he was back at the hospital after infecting who knows how many other people in his family, in his apartment complex, in his life.

We know of two people – “health care workers” is the euphemism they use. One we know was a nurse, the other just came out this morning and we don’t know much else.

The CDC immediately blamed the nurse for her own infection, saying she failed to follow proper procedures that would have isolated her from the now-dead Duncan’s bodily fluids. The nurses’ union fired back, claiming they hadn’t received enough training to know what the proper procedures were.

Blame, blame and more blame. The Texas Health Presbyterian Hospital completely bungled Duncan’s case from the get-go. The nurse & the other infected health care worker bungled their isolation processes. The CDC (and thus the US gov’t) bungled the dissemination of information and training. There’s plenty of blame to go around, but in the meantime, people keep getting infected.

Now we get to the big blame, though, and this is the blame that’s going to prevent not the isolation of Ebola in the United States, but the treatment or preparation of Americans moving forward.

The US government – and that means Congress and the Executive Office – have been steadily cutting budgets for science, technology & research for the better part of a decade. They deem other things more important – defense, for example, which gets the largest chunk of the US budget overall.

The sequester REALLY put the squeeze on research budgets, but that only kicked in last year. The real damage was done long before the sequester.

Without high science & research budgets, scientists & medical programs have to carefully pick and choose where they’re going to put their money – and their effort. I believe these things must be carefully chosen anyway, but because of the budget squeeze, nobody in the US has been putting much money – or effort – into researching and finding a vaccine or cure for Ebola. After all, it’s an African disease, right? There’s not much money to be made in preventing or curing a disease that’s just in Africa, so the pharmaceutical companies haven’t been really into it. They are, after all, profit-driven entities just like any other business. Americans, in general, don’t feel threatened by African diseases.

Maybe now that Ebola has reached the US and is starting to spread – and don’t even begin to think that there won’t be more cases popping up in Dallas – scientists & pharma companies will ramp up their efforts. When an American who contracted the virus in America dies, maybe the public will start to take Ebola as seriously as it needs to be taken.

Maybe, maybe, maybe. If wishes were fishes, we’d never go hungry.

Ebola can’t be wished away. It can, however, be scienced away. It’s time for the US government to step up and start dumping money and effort into finding not just a vaccine to prevent new Ebola infections, but a cure for this dreadful disease if at all possible. Ebola has to be stopped in West Africa before it spreads to more countries there – countries with even poorer containment capabilities than the countries where it already exists.

The USA has started sending soldiers to West Africa to build treatment facilities, but until a lot of things change, what they’re really building is holding facilities where infected people can go to wait and die.